Incidence and Prophylaxis of HIV Infection in Sexually Abused Children ChanthanaVitavasiri MD. Saowanee Kerdornfake MD. UbolChumjinda MattikaTapayantra ChutimaPantu

Objective 1.To obtain the incidence of HIV infection in sexually abused children 2.To study post-exposure prophylaxis and follow up for rape victims

Method Counseling Physical Examination Pelvic or Rectal Examination Blood testing Follow up Jan Dec 2001,children below 15 years of age, who came to verify sexual abuse were offered,

Criteria for HIV prophylaxis 1. Status HIVAb negative 2. Verify sexual assault 3. Come to the hospital within 72 hours 4.Rapist’s status HIVAb positive, high risk profile 5. Agree or consent to follow up

Results AgeERCounselBl.test Total % Children under 15 who came to verity, counsel and blood testing

AgeBl.testHBsAgHBsAbHIVAbVDRL Total % Initial Blood Testing 1 case VDRL-neg TPHA+ve

Rapist status

Time from sexual assault to Police General Hospital Time No.

Sexual assault verification result Type of positive finding No. PE=physical Examination PV= Pelvic Examination PR=Per Rectal Examination AP= Alkaline Phosphatase S = Sperm Normal PV,P R PE,PV, AP PV,AP, S PE,PR,AP PE,PV, AP PE,PV,A P,S

AgeBl.testARV28 days6 m FU Total % PEP children, complete ARV course, and 6 month follow up

HIV infected children A/0AgeDuratio n RapistRelationPEPVAPSHIVAb 0 HIVAb 6 m Mar.1, 00321Uncle-+--Pos Jun. 19, 00811Father----Pos Dec. 5, hr.3Acquaint ance ++--Negpos Apr.18, m1Father;s frieed -+--Pos *Sep 14, m1Neighbo ur -+--Pos *Rapist : pos HIVAb, HCVAb, HBsAb

Risk of HIV transmission 1. Virus (Viral load,Virulence,Resistant strain) 2. Route (Anal,Vaginal,Oral) 3. Ulcerative or Inflammation 4. Trauma, Bleeding 5. Times 6. Others; Menstruation, IUD Circumcision

Discussion Probability of transmission of HIV from single exposure Percutaneous Exposure Receptive anal Insertive anal Receptive vaginal Insertive vaginal Receptive fellalio with ejaculation

Conclusion Incidence HIV infection in sexually abused children In the Police General Hospital 0.88%

Triple drugs prophylaxis should be considered in * HIV infected rapist * Anal exposure * More than one attacker * Seriously injured victims

Thank you